Borderline persona dysfunction (BPD) is a psychological well being situation that impacts how individuals assume, really feel and relate to others. It may be deeply distressing for the individual experiencing it, for his or her family members and the professionals making an attempt to assist. Though individuals typically disagree concerning the label for this situation, what actually issues is guaranteeing individuals entry evidence-based assist after they want it most.
Many individuals don’t realise this, however no remedy is formally authorised to deal with BPD within the UK, US or Europe (Gartlehner, 2021, NICE, 2009). As an alternative, the most important remedy really useful by consultants is psychological remedy (NICE, 2009).
However right here’s the real-world twist: regardless of these suggestions, psychiatric drugs are generally prescribed, typically throughout a number of sorts of medicine. These embrace antidepressants, antipsychotics, sedatives, and temper stabilisers (Paton, 2015). A big European research of over 2,000 hospitalised sufferers with BPD discovered that 9 out of ten sufferers had been on remedy, with greater than half taking three or extra medicine directly (Bridler, 2015). Related findings have been noticed throughout completely different settings, the place over 50% of individuals with BPD had been prescribed three or extra psychiatric drugs (Tennant, 2023). Even long-term, information confirms that folks with BPD are persistently extra doubtless than these with different persona issues to take a number of psychiatric medicine (Zanarini, 2015).
On the identical time, some newer analysis suggests there could also be short-term advantages from sure drugs. For instance, a Finnish inhabitants research, lately summarised in a Psychological Elf Weblog, discovered that antipsychotics had been linked with decrease charges of suicide makes an attempt and violent behaviour in individuals with persona issues (Herttua, 2023).
So, why is prescribing in BPD so frequent? And what does it inform us about psychological well being in follow?
A current research led by Joshua Confue and colleagues (2025) explored this query. Their findings present an necessary glimpse into how psychological well being look after BPD really works and the place it would want to enhance.
Whereas psychological therapies are remedy really useful in pointers, it is not uncommon for individuals with a BPD prognosis to be prescribed remedy.
Strategies
The researchers did a scientific overview, a kind of research all of the related analysis on a subject to attract conclusions. They looked for research printed since 1994 and centered on why drugs are prescribed for adults with BPD, together with sufferers with different co-existing psychological well being situations (comorbidity).
They examined a number of main analysis databases, protecting a broad vary of research varieties, together with each numbers-driven analysis and research that discover individuals’s experiences. This mixture helps seize the complexity of prescribing remedy for BPD, which includes each medical information and human components.
From 102 research recognized initially, 13 research from completely different international locations had been included within the evaluation. It’s attainable that smaller research not printed in mainstream journals and databases weren’t captured.
Outcomes
The 13 research diverse in pattern measurement, from 9 to 550 contributors.
Individuals with BPD had been extra more likely to be prescribed drugs if:
- They had been older
- They’d different psychological well being situations (often melancholy or anxiousness)
- They’d been hospitalised previously
- They had been seen as posing a threat to themselves or others.
In different phrases, prescribing wasn’t nearly BPD, it was typically about what else was happening.
In some research, greater than 50% of sufferers had been prescribed three or extra psychiatric drugs.
Research that regarded into the experiences of execs prescribing drugs and sufferers gave a extra detailed image of the explanations behind the numbers. Nevertheless, solely two research checked out affected person views.
The researchers counsel that medical doctors typically really feel strain to behave, particularly in disaster conditions. Prescribing can really feel like “doing one thing” within the face of affected person struggling.
Additionally they counsel that some sufferers might anticipate drugs, and never prescribing them can pressure the therapeutic relationship.
Lastly, the overview group counsel that nationwide pointers are troublesome to use within the context of real-world complexity as restricted entry to therapies or constrained service time can enhance reliance on remedy.
Professionals stated that nationwide pointers had been laborious to implement in actual world complicated situations.
Conclusions
The authors concluded that though medical steerage advises in opposition to routine remedy use for BPD, prescribing is frequent and influenced by a number of components. These embrace affected person components resembling age, different situations and presenting signs but additionally clinician emotion, relationships between clinicians and sufferers, and systemic pressures.
This overview highlights the explanations behind the disconnect between evidence-based suggestions and the medical actuality, but additionally recognises that restricted analysis exists on the components at play.
General, whereas additional analysis is required, this overview offers a promising basis for understanding prescribing behaviours in BPD and growing methods to enhance outcomes for these sufferers.
There’s a disconnect between evidence-based suggestions and medical actuality, however restricted analysis exists on the components at play.
Strengths and limitations
This is among the first systematic critiques to deliver collectively proof on what drives prescribing selections in BPD. That alone makes it an necessary contribution, as a result of regardless of excessive charges of remedy use in follow, the explanations behind this have hardly ever been synthesised in a structured method.
An enormous energy of this overview is the best way it combines very various kinds of proof. As an alternative of focusing solely on numbers, the authors introduced collectively statistical research and qualitative analysis that included affected person and clinician views. This provides a richer image of why prescribing occurs.
The authors discovered that comorbidity performs a job in prescribing selections. Nevertheless, due to the character of the research included, it isn’t at all times attainable to find out whether or not drugs had been prescribed for BPD signs or for co-existing situations resembling melancholy or anxiousness.
Following worldwide requirements (PRISMA) ensured the overview was carried out transparently and systematically. However, solely 13 research met inclusion standards, and most had comparatively small pattern sizes. This limits how confidently the findings might be utilized to all sufferers with BPD.
Numerous proof offers perception, however small research numbers restrict how broadly the conclusions might be utilized.
Implications for follow
This overview highlights that prescribing in borderline persona dysfunction is never an easy, guideline-driven resolution. As an alternative, it’s formed by a mixture of medical, relational, and organisational components.
Sure affected person demographics resembling age, comorbidity, and symptom profile are necessary when making prescribing selections. Nevertheless, expectations of care and relationships between professionals and sufferers additionally have an effect on the probability of individuals with BPD receiving drugs. Many clinicians reported prescribing to ease misery, to keep up belief, or as a result of they felt helpless when different choices weren’t out there. This factors to a sensible reality: bettering prescribing in BPD isn’t solely about following pointers, it’s about strengthening the therapeutic relationship and ensuring each sufferers and professionals really feel supported. The place long-term therapies are troublesome to entry, prescribing might change into a default.
Given the excessive prevalence of prescribing regardless of restricted proof of profit, there’s a have to systematically monitor, and research potential drawbacks, uncomfortable side effects, or long-term issues of those drugs in individuals with BPD.
As BPD typically co-exists with different psychological well being situations (Shah, 2018), some prescriptions might goal co-occurring situations like melancholy or anxiousness somewhat than BPD itself. Understanding this helps clarify a part of the image.
Within the medical world, it is vital that:
- Clinicians are clear with sufferers about why drugs are prescribed, together with what remedy can and can’t do, so expectations are sensible.
- Clinicians can replicate on prescribing decisions. Is remedy is getting used for signs, to protect the connection, or due to strain?
- Healthcare companies prioritise continuity of care as sufferers worth consistency and belief, which may generally cut back reliance on prescribing as a “holding” measure.
- Remedy is accessible, as a result of with out it, each sufferers and clinicians might really feel left with few options.
Prescribing in BPD sits on the intersection of proof, human relationships, and system constraints. Recognising this complexity might help transfer follow away from automated prescribing, in direction of care that’s extra considerate, clear, and patient-centred.
Prescribing in BPD sits on the intersection of proof, human relationships, and system constraints.
Hyperlinks
Main paper
Confue J, Maidment I, Jones S, Jones M (2025) Elements that affect prescribing in borderline persona dysfunction: a scientific overview. Character and Psychological Well being 19(2): e70014.
Different references
Bridler, R., Häberle, A., Müller, S. T., Cattapan, Okay., Grohmann, R., Toto, S., Kasper, S., & Greil, W. (2015). Psychopharmacological remedy of 2195 in-patients with borderline persona dysfunction: A comparability with different psychiatric issues. European Neuropsychopharmacology, 25(6), 763–772.
Gartlehner G, Crotty Okay, Kennedy S et al (2021) Pharmacological remedies for borderline persona dysfunction: a scientific overview and meta-analysis. CNS Medicine 35: 1053-67.
Nationwide Institute for Well being and Care Excellence (2009) Borderline persona dysfunction: recognition and administration. NICE Medical Guideline CG78.
Paton, C., Crawford, M. J., Bhatti, S. F., Patel, M. X., & Barnes, T. R. (2015). The usage of psychotropic remedy in sufferers with emotionally unstable persona dysfunction underneath the care of UK psychological well being companies. The Journal of medical psychiatry, 76(4), e512–e518.
Shah R, Zanarini MC (2018) Comorbidity of borderline persona dysfunction: present standing and future instructions. Psychiatr Clin North Am 41:583–593.
Tennant, M., Frampton, C., Mulder, R., & Beaglehole, B. (2023). Polypharmacy within the remedy of individuals recognized with borderline persona dysfunction: Repeated cross-sectional research utilizing New Zealand’s nationwide databases. BJPsych Open, 9(6), e200.
Zanarini, M. C., Frankenburg, F. R., Reich, D. B., Harned, A. L., & Fitzmaurice, G. M. (2015). Charges of psychotropic remedy use reported by borderline sufferers and axis II comparability topics over 16 years of potential follow-up. Journal of Medical Psychopharmacology, 35(1), 63–67.
